Real-world implementation of video-observed therapy in an urban TB program in the United States.
Real-world implementation of video-observed therapy in an urban TB program in the United States.
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DOI：
10.5588/ijtld.21.0170
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发表时间：
2021-08-01
期刊：
影响因子：
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通讯作者：
Shah M
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文献类型：
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作者：
Perry A;Chitnis A;Chin A;Hoffmann C;Chang L;Robinson M;Maltas G;Munk E;Shah M
引入视频直接观察治疗（vDOT）以增加灵活性并满足患者对结核病治疗的特定需求。本研究旨在评估2018年至2020年美国加利福尼亚州阿拉米达县（一个忙碌的城市环境）常规条件下vDOT治疗结核病的范围和有效性。我们前瞻性评价了常规收集的数据，以估计1）覆盖范围（vDOT vs.当面DOT启动的患者比例）;和2）有效性（vDOT vs.当面DOT经验证给药的处方剂量比例）。在163名TB患者中，94名（58%）在治疗期间使用vDOT，其中54名（57%）仅接受vDOT。接受vDOT的个体平均年龄比接受面对面治疗的个体年轻（46岁对61岁; P <0.001）。至vDOT启动的中位时间为2.2周（IQR 1.1 - 10.0）;患者监测的中位时间为27.0周（IQR 24.6 - 31.9）。vDOT导致经验证的处方剂量比例高于亲自DOT（68% vs. 54%; P <0.001）。所有患者均在周末根据临床指示进行未观察的自我给药，但在现场DOT期间自我给药的比例高于vDOT（45% vs. 24%; P <0.001）。一个结核病项目成功地维持了vDOT，覆盖了大多数患者，并实现了比亲自DOT更大的药物验证。
Video directly observed therapy (vDOT) was introduced to increase flexibility and meet patient-specific needs for TB treatment. This study aimed to assess the reach and effectiveness of vDOT for TB treatment under routine conditions in Alameda County, CA, USA, a busy, urban setting, from 2018 to 2020. We prospectively evaluated routinely collected data to estimate 1) reach (proportion of patients initiated on vDOT vs. in-person DOT); and 2) effectiveness (proportion of prescribed doses with verified administration by vDOT vs. in-person DOT). Among 163 TB patients, 94 (58%) utilized vDOT during treatment, of whom 54 (57%) received exclusively vDOT. Individuals receiving vDOT were on average younger than those receiving in-person therapy (46 vs. 61 years; P < 0.001). The median time to vDOT initiation was 2.2 weeks (IQR 1.1–10.0); patients were monitored for a median of 27.0 weeks (IQR 24.6–31.9). vDOT led to higher proportions of verified prescribed doses than in-person DOT (68% vs. 54%; P < 0.001). Unobserved self-administration occurred for all patients on weekends based on clinic instructions, but a larger proportion of doses were self-administered during periods of in-person DOT than of vDOT (45% vs. 24%; P < 0.001). A TB program successfully maintained vDOT, reaching the majority of patients and achieving greater medication verification than in-person DOT.